Objective To analyze the correlation between serum soluble Klotho protein(sKL)and tendino-C(TN-C)and the severity of disease and oxidative stress in children with immunoglobulin A(IgA)nephropa-thy.Methods A total of 85 children with IgA nephropathy admitted to the hospital from July 2019 to August 2022 were selected as IgA nephropathy group,and 85 healthy patients who underwent physical examination in the hospital during the same period were selected as healthy group.Serum sKL and TN-C levels were com-pared between the two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the value of serum sKL,TN-C and their combination in predicting the occurrence of IgA nephropathy.IgA nephropathy group was divided into mild group(28 cases),moderate group(39 cases)and severe group(18 cases)accord-ing to 24 h urinary protein quantity.Serum sKL,TN-C levels and oxidative stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD)and advanced oxidation protein product(AOPP)]of the three groups were compared.The correlation between serum sKL and TN-C levels and oxidative stress indexes was ana-lyzed by Spearman correlation,and the correlation between serum sKL and TN-C levels and the severity of IgA nephropathy in children was examined by Kendall's Tau-b.Results The serum sKL level in IgA ne-phropathy group was lower than that in healthy group,and the serum TN-C level was higher than that in healthy group,the difference was statistically significant(P＜0.05).ROC curve showed that the area under the curve and 95％CI of serum sKL,TNC and their combination predicted the occurrence of IgA nephropathy were 0.726(95％CI:0.648-0.803),0.853(95％CI:0.796-0.909)and 0.891(95％CI:0.845-0.937).The level of serum sKL in severe group was lower than that in moderate and mild groups,while the level of serum TN-C was higher than that in moderate and mild groups,and the difference was statistically significant(P＜0.05).The serum SOD level of severe group was lower than that of moderate group and mild group,and the serum AOPP and MDA levels were higher than those of moderate group and mild group,the difference was statistically significant(P＜0.05).Spearman correlation showed that sKL level was positively correlated with SOD(r＞0,P＜0.05),and negatively correlated with AOPP and MDA(r＜0,P＜0.05).TN-C level was negatively correlated with SOD(r＜0,P＜0.05),and positively correlated with AOPP and MDA(r＞0,P＜0.05).Conclusion The levels of serum sKL and TN-C in children with IgA nephropathy are related to the severity of disease and oxidative stress,and the combination of SKL and TN-C can effectively predict the occurrence of IgA nephropathy.

Objective: To determine the active components of Eupolyphaga sinensis Walker (Tu Bie Chong) and explore the mechanisms underlying its fracture-healing ability. Methods: A modified Einhorn method was used to develop a rat tibial fracture model. Progression of bone healing was assessed using radiological methods. Safranin O/fast green and CD31 immunohistochemical staining were performed to evaluate the growth of bone cells and angiogenesis at the fracture site. Methylthiazoletetrazolium blue and wound healing assays were used to analyze cell viability and migration. The Transwell assay was used to explore the invasion capacity of the cells. Tubule formation assays were used to assess the angiogenesis capacity of human vascular endothelial cells (HUVECs). qRT-PCR was used to evaluate the changes in gene transcription levels. Results: Tu Bie Chong fraction 3 (TF3) significantly shortened the fracture healing time in model rats. X-ray results showed that on day 14, fracture healing in the TF3 treatment group was significantly better than that in the control group (P = .0086). Tissue staining showed that cartilage growth and the number of H-shaped blood vessels at the fracture site of the TF3 treatment group were better than those of the control group. In vitro, TF3 significantly promoted the proliferation and wound healing of MC3T3-E1s and HUVECs (all P < .01). Transwell assays showed that TF3 promoted the migration of HUVECs, but inhibited the migration of MC3T3-E1 cells. Tubule formation experiments confirmed that TF3 markedly promoted the ability of vascular endothelial cells to form microtubules. Gene expression analysis revealed that TF3 significantly promoted the expression of VEGFA, SPOCD1, NGF, and NGFR in HUVECs. In MC3T3-E1 cells, the transcript levels of RUNX2 and COL2A1 were significantly elevated following TF3 treatment. Conclusion TF3 promotes fracture healing by promoting bone regeneration associated with the RUNX2 pathway and angiogenesis associated with the VEGFA pathway.

Objective To investigate the correlations of serum Apelin-13 and fatty acid binding protein 4 (FABP4) levels with metabolic and bone metabolic indicators in postmenopausal women with different bone mass. Methods A total of 145 postmenopausal women were selected as subjects and divided into three groups based on bone mineral density (BMD) test results: normal bone mass group(49 cases), osteopenia (ON) group(51 cases), and osteoporosis (OP) group(45 cases). Serum Apelin-13, FABP4 levels, bone metabolic indicators, and biochemical indicators were measured and compared among the three groups. Spearman correlation analysis was used to analyze the correlations of Apelin-13, FABP4, and other indicators with BMD. Multivariate Logistic regression analysis was performed to analyze the risk factors for OP, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of serum Apelin-13 for postmenopausal osteoporosis (PMOP). Results The serum Apelin-13 level in the OP group was lower than that in the ON group and the normal bone mass group (P < 0.05). No significant difference in serum FABP4 levels was found among the three groups (P>0.05). The levels of serum parathyroid hormone (PTH), alkaline phosphatase (ALP), type Ⅰ procollagen amino-terminal propeptide (PⅠNP), type Ⅰ collagen cross-linked C-terminal peptide (CTXⅠ), and bone-specific alkaline phosphatase (BALP) in the OP group were higher than those in the ON group and the normal bone mass group (P < 0.05). Lumbar post-menopause BMD was positively correlated with serum Apelin-13 levels (P < 0.05), but had no correlation with serum FABP4 levels (P>0.05). Lumbar BMD was negatively correlated with serum PTH, ALP, PⅠNP, CTXⅠ, BALP, and age (P < 0.05), but positively correlated with body weight, body mass index, T-score, fasting insulin, and insulin resistance index (P < 0.05). Multivariate Logistic regression analysis showed that serum Apelin-13, PTH, ALP, PⅠNP, CTXⅠ, and BALP levels were independent factors influencing the occurrence of OP in postmenopausal women (P < 0.05). ROC curve results showed that the optimal cut-off value of serum Apelin-13 for predicting PMOP was 18.51 pg/mL, with an area under the curve of 0.716, a sensitivity of 70.0%, and a specificity of 64.4%. Conclusion Apelin-13 is lowly expressed in the serum of PMOP patients, and its expression level is closely related to lumbar BMD, which may serve as an early screening indicator and potential therapeutic target for PMOP.

Objective:To explore the application value of ultrasound diaphragmatic function assessment in weaning from invasive mechanical ventilation in patients with respiratory failure.Method:Fifty-three patients with acute respiratory failure who underwent mechanical ventilation and weaning in People’s Hospital Affiliated to Ningbo University from January 2020 to February 2022 were selected for research. After weaning conditions, T-tube was used for spontaneous breathing test (SBT). At SBT-30 min, beside ultrasound was used to collect the right diaphragm movement (DE) and diaphragm thickness, and the shallow rapid breathing index (RSBI), diaphragm shallow rapid breathing index (D-RSBI) and diaphragm thickness change rate (DTF) were calculated. According to the outcome of weaning, the patients were divided into the successfully weaned group and unsuccessfully weaned group. All patients’ clinical data were collected, and the relationship between ultrasound parameters and clinical indexes was compared between the two groups The efficiency of each index for predicting the success rate of weaning was analyzed with the receiver operating characteristic (ROC) curve.Results:Fifty-three patients were enrolled in this study, including 36 patients in the successfully weaned group and 17 patients in the unsuccessfully weaned group. DE and DTF in the successfully weaned group were higher than those in the unsuccessfully weaned group (all P<0.05), RSBI and D-RSBI in the successfully weaned group were significantly lower than those in the unsuccessfully weaned group (all P<0.05). ROC curve analysis showed that when the cut-off value of DE, DTF, RSBI and D-RSBI were >1.21 cm, >27.5%, <48.68 times/(min·L) and <1.31 times/(min·mm), the sensitivity of predicting the success of weaning was 69.0%, 97.2%, 83.0% and 83.0% respectively, and the specificity was 59.0%, 47.1%, 94.1% and 94.3%, respectively. Conclusions:The evaluation of ultrasound diaphragmatic function can effectively guide the clinical mechanical ventilation patients to withdraw the machine, and improve the accuracy of predicting the success rate of weaning. Therefore, t ultrasound diaphragmatic function assessment has a high application value in guiding the mechanical evacuation of patients with mechanical ventilation, and can be widely applied in clinical practice.

Objective This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials(RCTs)assessing the clinical efficacy of acupuncture for chronic stable angina(CSA).Methods PubMed,The Cochrane Library,Embase,CNKI,VIP,WanFang Data,CBM databases,ClinicalTrial.gov and Chinese Clinical Trial Registry were electronically searched to collect randomized controlled trials(RCTs)of acupuncture for CSA and only RCTs that included acupuncture as the sole or combination of acupuncture in the treatment of CSA.The retrieval period was from the establishment of the database to May 19,2022.The primary outcome measure was the frequency of angina attacks,and the secondary outcome measures were angina efficacy,total effective rate of ECG improvement,nitroglycerin use after treatment,patient-perceived overall effectiveness,performance on the Six-Minute Walk Test(6-MWT),depression as measured by the anxiety as measured by the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),adverse effects.Results Twelve studies with a total of 1605 case subjects were included and grade quality of evidence reviews had 1 outcomes as medium quality evidence,5 outcomes as low quality evidence and 4 outcomes as very low quality evidence.Acupuncture treatment resulted in significantly greater reductions in angina attacks,visual analog scale(VAS),6-minute walk test,angina efficacy,electrocardiogram improvement rate,angina efficacy,total clinical response rate.Conclusion The efficacy of acupuncture combined with western medicine in treating CSA is better than that of Western medicine alone,thanks to restricted by the number and quality of included researchs,higher quality studies are required to prove above conclusions.

The relationship between chronic psychological stress and tumorigenesis has been well defined in epidemiological studies; however, the underlying mechanism remains underexplored. In this study, we discovered that impaired macrophage phagocytosis contributed to the psychological stress-evoked tumor susceptibility, and the stress hormone glucocorticoid (GC) was identified as a principal detrimental factor. Mechanistically, GC disturbed the balance of the "eat me" signal receptor (low-density lipoprotein receptor-related protein-1, LRP1) and the "don't eat me" signal receptor (signal regulatory protein alpha, SIRPα). Further analysis revealed that GC led to a direct, glucocorticoid receptor (GR)-dependent trans-repression of LRP1 expression, and the repressed LRP1, in turn, resulted in the elevated gene level of SIRPα by down-regulating miRNA-4695-3p. These data collectively demonstrate that stress induces the imbalance of the LRP1/SIRPα axis and entails the disturbance of tumor cell clearance by macrophages. Our findings provide the mechanistic insight into psychological stress-evoked tumor susceptibility and indicate that the balance of LRP1/SIRPα axis may serve as a potential therapeutic strategy for tumor treatment.

Objective:To investigate the clinical predictive value of combined diaphragmatic and pulmonary ultrasound in acute respiratory failure patients with mechanical ventilation (MV).Methods:From January 2020 to August 2022, patients with acute respiratory failure admitted to People's Hospital Affiliated to Ningbo University who underwent invasive MV and weaning were enrolled. After meeting the weaning standards, spontaneous breathing test (SBT) was performed using T-tube. Right diaphragm excursion (DE), diaphragm thickness and lung ultrasound score (LUS) were collected by bedside ultrasound at 30 minutes of SBT, and rapid shallow respiratory index (RSBI), diaphragmatic-shallow respiratory index (D-RSBI) and diaphragmatic thickening rate (DTF) were calculated. According to the weaning outcome, the patients were divided into successful weaning group and failed weaning group. The clinical data of all patients were collected, and the ultrasound parameters and clinical indicators were compared between the two groups. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive value of D-RSBI, RSBI, DE combined with LUS score and DTF combined with LUS score for weaning failure patients.Results:A total of 77 patients were enrolled, including 54 cases in the successful weaning group and 23 cases in the failed weaning group. The right DE and DTF of patients in successful weaning group were significantly higher than those in failed weaning group [right DE (cm): 1.28±0.39 vs. 0.88±0.41, DTF: (32.64±18.27)% vs. (26.43±15.23)%, both P < 0.05], LUS score, RSBI and D-RSBI were significantly lower than those in failed weaning group [LUS score: 11.45±2.67 vs. 18.33±3.62, RSBI (times·min -1·L -1): 72.21±19.67 vs. 107.35±21.32, D-RSBI (times·min -1·mm -1): 0.97±0.19 vs. 1.78±0.59, all P < 0.05]. ROC curve analysis showed that when the cut-off value of D-RSBI and RSBI was 1.41 times·min -1·mm -1 and 56.46 times·min -1·L -1, the area under the ROC curve (AUC) for predicting weaning failure was 0.972 and 0.988; and the sensitivity was 95.7% and 87.0%, respectively; the specificity was 81.0% and 100.0%, respectively. The AUC of right DE combined with LUS score and DTF combined with LUS score in predicting weaning failure were 0.974 and 0.985, respectively, with a sensitivity of 91.3% and a specificity of 98.1%. Conclusions:Combined assessment of diaphragmatic and pulmonary ultrasound is a good parameter to effectively predict weaning failure in MV patients, which has high application value in guiding weaning in MV patients, and is worthy of clinical application.

Objective:To investigate the fertility intention and psychological pressure of women of childbearing age in Yanshan County, Jiangxi Province, and to provide data support for the targeted promotion of fertility.Methods:Using the method of random sampling, women of childbearing age in 10 communities in Yanshan County, Jiangxi Province were given questionnaires and psychological stress rating tables to understand the basic information, the status of marriage and childbearing, childbearing intentions, and the Chinese version of the Perceived Stress Scale (CPSS) score, and explore the related factors that may affect childbearing intentions and psychological stress of women of childbearing age.Results:In this survey, 1 500 questionnaires were distributed to women of childbearing age, 913 of which were returned, and 65.0%(593/913) of them were willing to have children. The CPSS score of women of childbearing age was 8-28(16.84±2.75). The CPSS scores of women of childbearing age in different occupations were statistically significant ( P<0.05). Public officials (including civil servants and employees of public institutions) had the least psychological pressure, while self-employed and other (unemployed) had the most psychological pressure. There was no significant difference in CPSS scores among women of childbearing age with different education levels, annual income levels, marital status and willingness to have children (all P>0.05). The correlation analysis showed that there was a statistical significance between the psychological pressure of women of childbearing age and their occupation ( r=0.230, P<0.05), and there was no significant correlation between other factors such as education level, annual income, fertility desire, fertility status, etc. and psychological pressure (all P>0.05). Conclusions:The fertility intention desire of women of childbearing age in Yanshan County, Jiangxi Province is basically normal, and the desire to have more children is not strong. There is no significant correlation between fertility intention and psychological pressure. The psychological pressure of women of childbearing age is significantly related to their occupation.

Objective:To explore the dynamic changes of inflammatory cytokines and T lymphocyte activation in the peripheral blood of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients during anti-retroviral therapy (ART).Methods:Two hundred and six HIV/AIDS patients with ART at clinic of the Department of Infectious Diseases in Second Xiangya Hospital, Central-South University between January 2017 and December 2019 were selected as HIV infection group. They were followed up regularly and the blood samples before treatment and at month 6, month 12, month 24 of treatment were collected. Meanwhile, 52 healthy cases were enrolled in the healthy control group and their blood samples were collected. Enzyme-linked immunosorbent assay was used to detect the plasma concentrations of interleukin (IL)-6, hypersensitive C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-α. Flow cytometry was used to detect the CD3 + CD4 + T lymphocytes count and the percentage of CD4 + CD38 + T lymphocytes and CD8 + CD38 + T lymphocytes in the peripheral blood mononuclear cells. Plasma HIV RNA viral load was determined using a quantitative real-time polymerase chain reaction technique. Statistical methods used paired t test and Pearson correlation analysis. Results:The concentrations of IL-6, hsCRP and TNF-α in HIV infection group were (13.42±2.35) pg/mL, (4 012.46±1 012.35) μg/L and (51.78±11.32) μg/L, respectively, which were higher than those in healthy control group ((6.14±0.78) pg/mL, (707.21±305.76) μg/L and (19.01±6.48) μg/L, respectively). The differences were all statistically significant ( t=12.56, 16.79 and 13.45, respectively, all P<0.001). They decreased gradually after initiation of ART in HIV infection group, and returned to normal levels at month 24 of ART. CD3 + CD4 + T cells count was (256.00±65.32)/μL and HIV RNA viral load was (4.467±4.244) lg copies/mL before ART in HIV infection group, which were negatively correlated ( r=-0.625, P=0.041). The percentages of CD8 + CD38 + T lymphocytes before treatment and at month 12 or month 24 of treatment in HIV infection group were higher than those in healthy control group. The differences were all statistically significant ( t=3.85, 6.84 and 2.57, respectively, all P<0.050). The percentage of CD8 + CD38 + T lymphocytes was positively correlated with HIV RNA viral load before ART ( r=0.768, P=0.026). The percentages of CD4 + CD38 + T lymphocytes before treatment and at month 12 or month 24 of treatment in the HIV infection group were lower than those in the healthy control group, and the differences were all statistically significant ( t=6.80, 1.10, and 2.11, respectively, all P<0.050). Conclusions:HIV infection could not only cause insufficiency in immune system, but also abnormal activation of immune system, which could get better gradually with ART.

Objective:To analyze and integrate the illness experience of female patients with systemic lupus erythematosus (SLE) .Methods:The qualitative studies on the illness experience in female SLE patients were searched in PubMed, Web of Science, CINAHL, the Cochrane Library, PsycINFO, China Biology Medicine disc, Wanfang Database, VIP, CNKI and other Chinese and English databases by computer. The retrieval period was from the database construction to April 30, 2021. The quality of the literature was evaluated using the Australian JBI Evidence-based Health Care Center (2017) Qualitative Research Quality Evaluation Standard, and the results were integrated and analyzed using the collection integration method.Results:A total of 9 literatures were included, which were classified into 13 categories and integrated into 4 integration results. First, the patients lacked disease knowledge, family and social support and they desired support. Second, the disease caused physical discomfort and impaired self-image to patients, and their daily life, work, and childbirth are restricted. Third, the disease brought a series of negative psychological experiences to patients. Fourth, patients learned to accept themselves and could actively adjust coping strategies.Conclusions:Over time, SLE patients can learn to accept themselves and coexist with the disease. It is recommended that medical staff give patients necessary guidance to help patients correctly understand the disease and provide individualized interventions to improve the quality of life of SLE patients.